Manual lymphatic drainage for lymphedema following breast cancer treatment

Ezzo, Jeanette; Manheimer, Eric; McNeely, Margaret L.; Howell, Doris; Weiss, Robert M.; Johansson, Karin; Bao, Ting; Bily, Linda; Tuppo, Catherine; Williams, Anne; Karadibak, Didem

doi:10.1002/14651858.cd003475.pub2

Cited by 206 publications

(244 citation statements)

References 100 publications

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“…This is largely due to difficulty detecting the specific impact MLD may have on the lymphatic system and surrounding tissue using conventional metrics. 2,18,19 Our findings revealed that non-MRI measurements (perometry, BIS, TDC) were largely confirmatory for discriminating between edematous and nonedematous limbs, yet these measures were insensitive to immediate tissue composition changes pre-versus post-MLD. However, quantitative deep tissue T 2 MRI values revealed significant changes after MLD in both the involved and contralateral quadrant.…”

Section: Discussionmentioning

confidence: 69%

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Bilateral Changes in Deep Tissue Environment After Manual Lymphatic Drainage in Patients with Breast Cancer Treatment-Related Lymphedema

Donahue

Crescenzi

Scott

et al. 2017

Lymphatic Research and Biology

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Background: Breast cancer treatment-related lymphedema (BCRL) arises from a mechanical insufficiency following cancer therapies. Early BCRL detection and personalized intervention require an improved understanding of the physiological processes that initiate lymphatic impairment. Here, internal magnetic resonance imaging (MRI) measures of the tissue microenvironment were paired with clinical measures of tissue structure to test fundamental hypotheses regarding structural tissue and muscle changes after the commonly used therapeutic intervention of manual lymphatic drainage (MLD). Methods and Results: Measurements to identify lymphatic dysfunction in healthy volunteers (n = 29) and patients with BCRL (n = 16) consisted of (1) limb volume, tissue dielectric constant, and bioelectrical impedance (i.e., non-MRI measures); (2) qualitative 3 Tesla diffusion-weighted, T 1 -weighted and T 2 -weighted MRI; and (3) quantitative multi-echo T 2 MRI of the axilla. Measurements were repeated in patients immediately following MLD. Normative control and BCRL T 2 values were quantified and a signed Wilcoxon Rank-Sum test was applied (significance: two-sided p < 0.05). Non-MRI measures yielded significant capacity for discriminating between arms with versus without clinical signs of BCRL, yet yielded no change in response to MLD. Alternatively, a significant increase in deep tissue T 2 on the involved (pre T 2 = 0.0371 -0.003 seconds; post T 2 = 0.0389 -0.003; p = 0.029) and contralateral (pre T 2 = 0.0365 -0.002; post T 2 = 0.0395 -0.002; p < 0.01) arms was observed. Trends for larger T 2 increases on the involved side after MLD in patients with stage 2 BCRL relative to earlier stages 0 and 1 BCRL were observed, consistent with tissue composition changes in later stages of BCRL manifesting as breakdown of fibrotic tissue after MLD in the involved arm. Contrast consistent with relocation of fluid to the contralateral quadrant was observed in all stages. Conclusion: Quantitative deep tissue T 2 MRI values yielded significant changes following MLD treatment, whereas non-MRI measurements did not vary. These findings highlight that internal imaging measures of tissue composition may be useful for evaluating how current and emerging therapies impact tissue function.

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Section: Discussionmentioning

confidence: 69%

“…Primarily quantified using limb volumetric assessment, MLD has been reported to have variable impact on outcomes. 2 For this reason, MLD effectiveness remains controversial as a component of CDT, resulting in uncertainty of best clinical practice for lymphedema management.…”

mentioning

confidence: 99%

Bilateral Changes in Deep Tissue Environment After Manual Lymphatic Drainage in Patients with Breast Cancer Treatment-Related Lymphedema

Donahue

Crescenzi

Scott

et al. 2017

Lymphatic Research and Biology

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“…Recent studies suggest that resistance exercise in women with breast cancer is both safe (when monitored appropriately), may decrease the risk of lymphedema development and clearly decreases the signs and symptoms of the condition [19,20]. In a recently published Cochrane review, the effects of manual lymphatic drainage independently and/or combined with exercise therapy have provided inconclusive results however, it was reported that shoulder mobility such as lateral movements and forward flexion were better when starting shoulder exercises earlier rather than later (after surgery) and that progressive resistance exercise therapy does not increase the risk of developing lymphedema [21]. Schmitz reported in 2010, that resistance training in breast cancer patients not only was indicated in rehabilitation programs, but also reported less lymphedema in her cohort [22].…”

Section: Surgical Complications: Lymphedemamentioning

confidence: 99%

Clinical Implementation of Exercise Guidelines for Cancer Patients: Adaptation of ACSM’s Guidelines to the Italian Model

Stefani

Galanti

Klika

2017

JFMK

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Abstract:The goal of cancer treatment is to arrest or eradicate the tumor while minimizing the often toxic effects of treatment. While oncologic diagnostics and treatments are improving and survival rates are increasing, it is critical to provide additional patient management that appears to affect long-term survival. Epidemiologic evidence suggests patients diagnosed with cancer tend to fair better after treatment when following a comprehensive rehabilitation program aimed at achieving an ideal body weight through dietary and exercise interventions while also increasing cardiorespiratory fitness, strength, mobility, neuromuscular integrity and psycho-social wellbeing. Additionally, it is now being tested whether exercise during cancer treatment and possibly prior to the start of treatment may increase post treatment outcomes by altering body weight, having direct effects on tumorigenesis, reducing oxidative stress and inflammation, and perhaps increasing chemotherapy delivery efficacy. The purpose of this review is to outline an evidence based model to evaluate cancer patients and provide guidelines for post-cancer treatment rehabilitation programs. Additionally, strategies aimed at changing lifestyle habits such as smoking and poor dietary habits will be addressed.

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“…There is also controversy over the role and safety of manual therapies and acupuncture in the management of lymphedema postcancer treatment (64,65). Although some studies have concluded that such treatment is safe even in areas with residual tumor (66)(67)(68), to date, no randomized prospective study has examined this issue. Meanwhile, there is virtually no basic research on physical manipulation of the connective tissue matrix surrounding tumors to influence the behavior of the tumor as it interacts with its surrounding matrix, or at distant sites to influence the receptivity of the matrix to metastatic seeding.…”

Section: Potential Effects Of Physical-based Treatments On Cancermentioning

confidence: 99%

Connecting (T)issues: How Research in Fascia Biology Can Impact Integrative Oncology

et al. 2016

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Complementary and integrative treatments, such as massage, acupuncture, and yoga, are used by increasing numbers of cancer patients to manage symptoms and improve their quality of life. In addition, such treatments may have other important and currently overlooked benefits by reducing tissue stiffness and improving mobility. Recent advances in cancer biology are underscoring the importance of connective tissue in the local tumor environment. Inflammation and fibrosis are well-recognized contributors to cancer, and connective tissue stiffness is emerging as a driving factor in tumor growth. Physical-based therapies have been shown to reduce connective tissue inflammation and fibrosis and thus may have direct beneficial effects on cancer spreading and metastasis. Meanwhile, there is currently little knowledge on potential risks of applying mechanical forces in the vicinity of tumors. Thus, both basic and clinical research are needed to understand the full impact of integrative oncology on cancer biology as well as whole person health. Cancer Res; 76(21); 6159-62. Ó2016 AACR.

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Manual lymphatic drainage for lymphedema following breast cancer treatment

Cited by 206 publications

References 100 publications

Bilateral Changes in Deep Tissue Environment After Manual Lymphatic Drainage in Patients with Breast Cancer Treatment-Related Lymphedema

Bilateral Changes in Deep Tissue Environment After Manual Lymphatic Drainage in Patients with Breast Cancer Treatment-Related Lymphedema

Clinical Implementation of Exercise Guidelines for Cancer Patients: Adaptation of ACSM’s Guidelines to the Italian Model

Connecting (T)issues: How Research in Fascia Biology Can Impact Integrative Oncology

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